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671 – BLS – Adult/Peds Pennsylvania Department of Health Trauma and Environmental 671 – BLS – Adult/Peds BURNS STATEWIDE BLS PROTOCOL Criteria: A. Thermal injury from exposure to intense heat B. Injury from electrical shock or lightning strike C. Skin injury from chemical exposure Exclusion Criteria: A. None Treatment: A. All patients: 1. Initial Patient Contact – see Protocol # 201. a. When dealing with hazards associated with burns (e.g. fire, electricity, chemicals) appropriate PPE must be worn and individuals with appropriate training should deal with these hazards. b. When triaging multiple patients with lightning injury, initial resources should be committed to individuals that have no sign of life (i.e. “reverse triage”) rather than individuals who have vital signs. c. Stop the burning process with water or saline. Caution- use care to avoid hypothermia. d. Immobilize C-spine, if indicated – See Cervical Spine Immobilization Protocol # 261. e. Consider call for ALS or air medical transport as appropriate. See Indications for ALS Use protocol #210. 2. Assure open airway and assist ventilations as needed. 1 3. Administer high concentration oxygen if: 2 a. Coughing or short of breath. b. Exposure to smoke in a confined space. c. Facial burns d. Burn area greater than 15% BSA. 4. Remove all clothing, jewelry and any debris from involved area. Cut around clothing that is stuck to wound. 5. Treat special conditions as follows: a. Semi-solids (tar, etc.): 1) Flush with cool water. b. Chemical burn: 1) Liquid substance - Irrigate with copious amounts of room temperature water. Do not contaminate uninjured areas while flushing. 2) Dry substances- With gloves and appropriate PPE, brush remaining powder from skin and clothing, then irrigate with copious amounts of water.3 c. Electrical: 1) Dress entrance and exit wounds and other injuries. 6. Care of burned skin: Effective 07/01/11 671-1 of 2 Pennsylvania Department of Health Trauma and Environmental 671 – BLS – Adult/Peds a. Cover burned areas with dry sterile burn sheets/ dressings or sterile commercial burn sheets/ dressings. b. Maintain body temperature. c. Estimate the extent of the burn using the Rule of Nines (See appendix). 7. Transport to the closest appropriate medical facility, as follows: a. If unable to maintain airway or unable to ventilate or patient has symptoms of shortness of breath / cough or inhalation injury suspected (for example burned nasal hairs or carbonaceous sputum) or if unable to control profuse bleeding, transport to closest hospital. b. If patient has associated trauma and meets trauma triage criteria, transport per Trauma Triage Protocol # 180. c. Transport to a burn center if: 1) The patient has burns to more than 15% BSA or burns to the face or hands, and 2) The patient does not meet trauma triage criteria, and 3) The difference between estimated transport time to the closest receiving facility and the burn center is 20 minutes or less. d. If patient meets none of the above, transport to closest hospital. e. Contact medical command if unsure of most appropriate destination. 8. Monitor vital signs and reassess Notes: 1. Caution: patients who have inhaled hot gases or have burns about the face or who have symptoms of shortness of breath or cough can deteriorate rapidly. 2. See Pulse Oximetry protocol #226. Pulse oximetry may only be used by BLS services and providers that meet DOH pulse oximetry requirements. If used, pulse oximetry must not delay the application of oxygen. Record SpO2 after administration of oxygen. If pulse oximetry is used and patient does not tolerate NRB mask, may switch to nasal cannula as long as SpO2 remains ≥94%. 3. Note- some substances, like dry lime will cause a heat-producing reaction when mixed with water. Copious water should be available before beginning to irrigate. Performance Parameters: A. Compliance with trauma triage and burn center destination protocols. B. Evaluate on scene times for non-entrapped burn victims. Victims that meet criteria for high concentration of oxygen should be transported rapidly. Possible benchmark for on scene time for unentrapped victims = 10 minutes. Effective 07/01/11 671-2 of 2 .
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